PART D PLANS SKIMPING ON MTM SERVICES, BRIEF CHARGES

NOVEMBER 01, 2006

The nation's pharmacists
are being frozen
out of medication therapy
management (MTM)
by Part D drug plans that
are failing to provide
meaningful MTM services
to seniors, health care
advocates charged. Those
allegations are a bitter
pill for organized pharmacy,
which fought for
and won provisions in the new Medicare drug law
requiring Part D drug plans to make MTM benefits
available to their members.

Despite that congressional mandate, however,
a brief prepared by the Medicare Rights
Center maintains that the majority of Part D
drug plans are not offering patients face-to-face
medication counseling and other MTM services
by trained pharmacists. According to the advocacy
group, the Centers for Medicare &
Medicaid Services (CMS) has given private
insurers too much discretion in the design of
the MTM services under Part D.

As a result, "the majority of popular plans are
only providing educational material by mail or over
the phone with in-house staff rather than face-toface
interaction with an independent pharmacist
or care team," officials at the Medicare Rights
Center charged. "Few plans provide comprehensive
medical review or follow-up."

Under the law, MTM services must be designed
"to optimize therapeutic outcomes through
improved medication use and to reduce the risk of
adverse events" for private Medicare drug plan
members who have multiple chronic diseases, are
taking multiple medications, or are likely to incur
high annual drug costs.

"If the Centers for Medicare & Medicaid
Services considers medication therapy management
to be the ‘cornerstone'of the Medicare
drug benefit, as it says, then it should regulate
private plans and not bow to them," said
Medicare Rights Center President Robert M.
Hayes. "Until CMS raises the bar and requires
profiteering drug plans to utilize the best medication
therapy management practices available
today, people will suffer needlessly and have
costly hospital and nursing homes stays."